Thursday, September 10, 2009

Identity crisis

‘Why are you not on inhalers’? [Inhaled steroids are the main stay in the treatment of chronic asthma] I asked. He did not respond but the sheepish look on his face told me that he has not been taking it. I asked him,’ where are my case notes’? He did not have them with him.

Here some explanation is required to understand this conversation between the patient and I. With rare exceptions all my regular patients carry my case records and some of these go back to over 40 years. They are a reflection of not only the quality of my practice but also the patient and his disease characteristics. I find it extremely upsetting when a patient comes without my notes because the treatment often depends on what I did when he visited last time. This patient had not only come without my records but also was not following my instructions. ‘When did you last see me’ I asked. Five years ago he said. This was a blatant lie. I knew Jayaram to be not a very good patient and often did not keep appointments and came whenever he was in trouble with his asthma and not when I had asked him to come. This led to my having problems of management and caused lot of worry. I had even told him last time he came, which was certainly not 5 years, that if he does not keep the appointment and regular follow up, he better find another doctor and I really meant it.

Here he is again up to his old antics and adding insult to injury was also lying.
I could barely control my anger. I told him to get lost and not to see again. He started saying something in placation. But I had enough of this man who had bothered me over the years and it is a good opportunity to get rid of him forever. He stood for while wiping his sweaty face and seeing me unrelenting, went out.

I got busy seeing other patients and after an hour or so, in walks Jayaram who must have been waiting outside. By then I too had cooled down. He said, ‘Sir, I really saw you five years ago and you did not put me on any inhalers and I did not see you for asthma, this is the first time I am seeing you for this trouble’. I had a closer look at him and asked,' are you not Jayaram?' He said, ‘Saab, my name is Abrar Ahmed, I am Abbas Ali’s nephew. You know my uncle very well’.

I could have sworn that the person in front is Jayaram but the fact was that this poor man who took the flack was indeed a different person with remarkably similar looks. My apologies were gracefully accepted and of course the treatment details are of no interest to you.

The errant Jayaram is still my patient and continues to persecute me!

Next week I will narrate another episode where in I had dropped a brick not once but twice.


Anonymous said...

When a patient goes to a doctor, he needs to be relieved of the pain.It is the doctor's duty to do just that immaterial of the kind of person he or she is.Had you treated him, looking at him purely as a patient, perhaps you would not have dropped a brick !

Dip said...

I appreciate your "rules" for carrying the treatment notes and visiting you on the appointed day.

Personally I have benefited from following these rules.

But may be you should be a Doctor first, when an irresponsible patient turns up; treat him as best as you can; and THEN drop the brick?